Anesthetic considerations in organ procurement surgery: a narrative review

Anderson, Thomas A.; Bekker, Peter L; Vagefi, Parsia A.

doi:10.1007/s12630-015-0345-8

Cited by 31 publications

(33 citation statements)

References 70 publications

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“…These movements have been generally dismissed as spinal cord reflexes despite the fact that they can also be mediated at the brainstem. Indeed, movements of donors are commonly observed in response to nociceptive stimuli during surgical procurement and are routinely masked by administering neuromuscular-blocking drugs to induce paralysis (Anderson et al 2015 ). However, analgesic and hypnotic drugs are not administered concurrently to relieve pain and suppress residual awareness that may be present in these donors.…”

Section: End-of-life Organ Donationmentioning

confidence: 99%

Campaigning for Organ Donation at Mosques

Rady

Verheijde

2016

HEC Forum

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There is a trend of recruiting faith leaders at mosques to overcome religious barriers to organ donation, and to increase donor registration among Muslims. Commentators have suggested that Muslims are not given enough information about organ donation in religious sermons or lectures delivered at mosques. Corrective actions have been recommended, such as funding campaigns to promote organ donation, and increasing the availability of organ donation information at mosques. These actions are recommended despite published literature expressing safety concerns (i.e., do no harm) in living and end-of-life organ donation. Living donors require life-long medical follow-up and treatment for complications that can appear years later. Scientific and medical controversies persist regarding the international guidelines for death determination in end-of-life donation. The medical criteria of death lack validation and can harm donors if surgical procurement is performed without general anesthesia and before biological death. In the moral code of Islam, the prevention of harm holds precedence over beneficence. Moral precepts described in the Quran encourage Muslims to be beneficent, but also to seek knowledge prior to making practical decisions. However, the Quran also contains passages that demand honesty and truthfulness when providing information to those who are seeking knowledge. Currently, information is limited to that which encourages donor registration. Campaigning for organ donation to congregations in mosques should adhere to the moral code of complete, rather than selective, disclosure of information. We recommend as a minimal standard the disclosure of risks, uncertainties, and controversies associated with the organ donation process.

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Section: End-of-life Organ Donationmentioning

confidence: 99%

Campaigning for Organ Donation at Mosques

Rady

Verheijde

2016

HEC Forum

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“…However, the exact mechanism of PRS remains to be elucidated, and there is a dearth of accurate predictors of severe PRS. During the past decade, LT from donation after circulatory death (DCD) grafts has increased dramatically worldwide due to the severe shortage of deceased liver grafts [ 7 – 9 ]. Unfortunately, DCD donors are always regarded as marginal donors or extended criteria donors (ECDs).…”

Section: Introductionmentioning

confidence: 99%

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

et al. 2017

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BackgroundsPredicting the occurrence of severe postreperfusion syndrome (PRS) is clinically challenging. We investigated whether the flushed fluid potassium concentration (FFK) was associated with severe PRS in deceased donor liver transplantation (DDLT).Material/MethodsForty adult DDLT recipients were enrolled in this retrospective study. Effluent solution samples were collected at the end of the portal vein flush, and the FFK was determined using a point-of-care blood gas analyzer. The risk factors associated with severe PRS and the clinical outcomes in 2 groups were compared.ResultsSevere PRS occurred in 22 out of 40 patients (55.0%). The FFK of the severe PRS group was significantly higher than that of the non-severe PRS group (median, 9.6 vs. 5.8, P<0.001). Other variables associated with severe PRS included the donor risk index (DRI), Child-Turcotte-Pugh score, donor type, donor warm ischemia time, and Model for End-stage Liver Disease score. The area under the receiver operator characteristic curve for the FFK was 0.982, and the best cut-off value of the FFK for predicting severe PRS was 6.75 mmol/L (100.0% sensitivity and 88.9% specificity). A significant positive correlation was observed between the FFK and DRI (R=0.714). Patients who experienced severe PRS had a higher early allograft dysfunction rate (63.6% vs. 22.2%, P=0.019) and a longer hospital stay (median, 33.0 vs. 24.0, P=0.034).ConclusionsBoth the severity of the recipient’s liver disease and the donor graft factors play an important role in the development of severe PRS in DDLT. An FFK of more than 6.75 mmol/L was associated with severe PRS after reperfusion.

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“…Our study aimed at describing current practices and perceptions of a large panel of anesthesiologists on the intraoperative management of BDD. The few existing recommendations on the subject are essentially based on expert opinions or extrapolated from ICU guidelines for BDD management [1,2].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: Results from a French survey

Champigneulle

Neuschwander

Bronchard

et al. 2019

Preprint

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Background: This study aimed at describing usual anesthetic practices for brain-dead donors (BDD) during an organ procurement (OP) procedure and to assess the knowledge and self-confidence of French anesthesiologists with this practice. Methods: An electronic and anonymous survey with closed-questions about anesthetic management of BDD was distributed to French anesthesiologists via the mailing list of the French Society of Anesthesiology and Intensive Care Medicine. Results: 458 responses were analyzed. Respondents were mainly attending physicians with more than 10 years of clinical experience. 78% of them declared being cognizant of guidelines regarding management of BDD. Advanced hemodynamic monitoring and endocrine substitution were rarely considered by respondents (31% and 35% of respondents, respectively). 98% of the respondents used crystalloids for fluid resuscitation. During the procedure, use of neuromuscular blockers, opioids and sedative agents were considered by respectively 84%, 61% and 27% of the respondents. A very high level of agreement (10 [8-10], on a ten-points Likert-style scale) was reported concerning the expected impact of intraoperative anesthetic management on the primary function of grafts. Conclusions: Declared anesthetic practice appeared in accordance with guidelines concerning organ donor management in the ICU. Further studies are needed to evaluate the specific impact of intraoperative management during this procedure and thus the need for specific anesthetic guidelines.

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Anesthetic considerations in organ procurement surgery: a narrative review

Cited by 31 publications

References 70 publications

Campaigning for Organ Donation at Mosques

Campaigning for Organ Donation at Mosques

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: Results from a French survey

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